First Online: 19 November 2011Received: 26 March 2011Accepted: 19 November 2011

Abstract

BackgroundComputerized physician order entry CPOE systems are recommended to improve patient safety and outcomes. However, their effectiveness has been questioned. Our objective was to evaluate the impact of CPOE implementation on the outcome of critically ill patients.

MethodsThis was an observational before-after study carried out in a 21-bed medical and surgical intensive care unit ICU of a tertiary care center. It included all patients admitted to the ICU in the 24 months pre- and 12 months post-CPOE Misys implementation. Data were extracted from a prospectively collected ICU database and included: demographics, Acute Physiology and Chronic Health Evaluation APACHE II score, admission diagnosis and comorbid conditions. Outcomes compared in different pre- and post-CPOE periods included: ICU and hospital mortality, duration of mechanical ventilation, and ICU and hospital length of stay. These outcomes were also compared in selected high risk subgroups of patients age 12-17 years, traumatic brain injury, admission diagnosis of sepsis and admission APACHE II > 23. Multivariate analysis was used to adjust for imbalances in baseline characteristics and selected clinically relevant variables.

ResultsThere were 1638 and 898 patients admitted to the ICU in the specified pre- and post-CPOE periods, respectively age = 52 ± 22 vs. 52 ± 21 years, p = 0.74; APACHE II = 24 ± 9 vs. 24 ± 10, p = 0.83. During these periods, there were no differences in ICU adjusted odds ratio aOR 0.98, 95% confidence interval CI 0.7-1.3 and in hospital mortality aOR 1.00, 95% CI 0.8-1.3. CPOE implementation was associated with similar duration of mechanical ventilation and of stay in the ICU and hospital. There was no increased mortality or stay in the high risk subgroups after CPOE implementation.

ConclusionsThe implementation of CPOE in an adult medical surgical ICU resulted in no improvement in patient outcomes in the immediate phase and up to 12 months after implementation.